Hidradenitis Suppurativa Surgery: What Are Your Options?

If you live with hidradenitis suppurativa (HS), you already know the worst part isn’t just the bumpsit’s the
repeat performances. Same spots. Same flare cycle. Same “I swear I was just here” feeling.
HS is a chronic inflammatory skin condition that often shows up in places where skin rubs together (like armpits,
groin, under breasts, and buttocks). Over time, it can form tunnels under the skin (often called sinus tracts),
scarring, and stubborn areas that don’t respond well to meds alone.

Surgery can be a real game-changer for the right person at the right time. But “HS surgery” isn’t one procedure
it’s a whole menu. Some options are small, in-office procedures. Others are bigger operations with longer healing.
This guide breaks down the main surgical and procedure-based options in plain English (with just enough humor to
keep things readable, not enough to make your dermatologist glare at you).

First, what surgery is actually trying to fix

HS has a few “layers” of problems, and surgery is mostly aimed at the ones that are structuralespecially
persistent tunnels and repeatedly inflamed, scarred areas. Medications can reduce inflammation and help prevent
new lesions, but they may not fully erase established tunnels or heavily scarred tissue. That’s why many treatment
plans use a combo approach: medical therapy to calm the disease + procedures to remove the troublemaking “hardware.”

Where surgery fits in (without making it sound like a final boss)

Surgery is often considered when:

• You have recurring flares in the exact same spot (especially with tunneling).
• There’s scarring or sinus tracts that don’t respond to medications.
• You have moderate-to-severe disease where long-term control needs more than one tool.
• Specific areas are “hot zones” while other areas are calmermaking localized procedures more useful.

Important note: none of this is DIY territory. HS procedures should be done by clinicians trained in dermatology,
dermatologic surgery, general surgery, or plastic surgerydepending on the location and severity.

Your HS surgery options (the practical, real-world breakdown)

1) Incision and drainage (I&D): fast relief, not a long-term fix

Incision and drainage is what many people imagine when they hear “surgery” for HS. A clinician opens a painful,
swollen area to relieve pressure. It can help with short-term pain relief when a flare is especially intense.
But here’s the catch: I&D usually doesn’t remove the lining of the tunnel or the diseased tissue that keeps
the area coming back. So recurrence is common, and many experts do not consider it a durable HS solution.

Think of I&D like letting air out of a balloon that keeps re-inflating. Helpful in the moment, but not the
whole plan.

2) Deroofing (also called “unroofing”): a tunnel-focused, tissue-sparing option

Deroofing is one of the most talked-about HS procedures for a reason: it targets tunnels (sinus tracts) while
sparing more healthy surrounding skin than larger excisions. The clinician removes the “roof” over a tunnel so the
base can heal from the inside out. It’s often used for recurring tracts and localized disease, commonly in Hurley
stage I–II areas.

Many deroofing procedures can be done with local anesthesia (numbing medicine), and healing typically happens by
“secondary intention,” meaning the wound closes gradually as new tissue forms. The trade-off is that wound care can
take time, and you’ll want a clear plan for dressings, friction reduction, and follow-up.

3) Limited (local) excision: removing a defined HS spot

Limited excision removes a smaller, clearly defined area of HS-involved skin and tissue. Compared with deroofing,
local excision may remove deeper and/or broader tissue in that one spot, and the wound may be closed with stitches
when appropriate. This can be useful when the disease is localized but more extensive than a single tunnel.

Recurrence can still happenespecially if HS is active around the edgesso the best outcomes often come from
pairing surgery with a medical plan aimed at controlling inflammation overall.

4) Wide excision (wide local excision / radical excision): the big tool for severe or extensive HS

Wide excision removes a larger block of HS-involved skin and underlying tissue. This approach is commonly used for
more advanced disease (often Hurley stage III) or areas with extensive interconnected tunnels and scarring.
Compared with smaller procedures, wide excision tends to have lower recurrence rates in many studies, but it also
comes with bigger wounds, longer healing time, and potentially more complex reconstruction.

How the wound gets closed (or not)

After wide excision, closure options may include:

• Healing by secondary intention: letting the wound heal gradually from the bottom up.
• Primary closure: stitching closed when the defect is small enough and tension is manageable.
• Skin grafts: placing skin from another site to cover the wound.
• Flaps: moving nearby tissue to cover the area (often used in complex locations).

There isn’t one “best” closure for everyone. Location, size, mobility needs, and surgeon expertise matter a lot.

5) Laser-based options: hair reduction, tract work, and targeted removal

Lasers can play different roles in HS care. One role is laser hair removal (commonly using Nd:YAG 1064 nm and other
devices depending on skin tone and hair characteristics). By reducing hair and follicular activity in affected
areas, laser hair removal may help some peopleespecially with mild-to-moderate HS.

Another role is using lasers to treat HS lesions and tunnels more directly. CO₂ laser approaches, for
example, have been described for removing or “unroofing” sinus tracts. Laser procedures vary widely by clinic and
technique, so ask what type is used, what the goal is (hair reduction vs tract treatment), and what outcomes are
realistic.

6) Tissue-sparing excision techniques (like STEEP) and electrosurgery

Some dermatologic surgeons use tissue-sparing techniques designed to remove HS-affected tunnel systems while
preserving as much healthy tissue as possible. You may hear terms like STEEP (skin-tissue-saving excision with
electrosurgical peeling). These approaches are evolving and may be offered by specialized HS centers.

A quick comparison table (because your brain deserves a shortcut)

How doctors decide which option fits you

Choosing the right procedure is usually less about “best surgery” and more about “best match.” Clinicians often
weigh:

• Severity and pattern: localized tunnels vs widespread interconnected disease.
• Location: armpit movement, groin friction, and skin tension change healing strategy.
• Hurley stage: helpful for staging, but your day-to-day symptoms matter too.
• Your lifestyle reality: work, school, caregiving, sports, commuting, and your ability to do wound care.
• Medical factors: smoking, diabetes, immune-suppressing meds, and prior surgeries can affect healing.

It’s also normal to use more than one approach over time. Many people have a “primary trouble area” handled with a
procedure while also using medications to reduce new flares elsewhere.

Yes, medications still mattereven when surgery is on the table

For moderate-to-severe HS, biologic medications have become an important part of care. In the U.S., several
biologics have FDA-approved indications for HS in adults, and dermatologists often combine medical therapy with
procedures for better long-term control. The exact plan (including how to time meds around surgery) should be
tailored with your dermatologist and surgeon.

What recovery can look like (so you can plan like a pro)

Before the procedure

Expect a discussion about goals (pain relief? fewer flares? improved mobility?), what will be removed, and how the
wound will heal. You may also be asked about medications, smoking, and any conditions that affect healing. If your
HS is very active, clinicians sometimes prefer to operate when inflammation is calmerbecause it can make surgery
and healing smoother.

The day of

Smaller procedures (like many deroofings) may be done in-office with local anesthesia. Larger excisions may happen
in a surgical center with sedation or general anesthesia. Ask what pain control plan will be used during and after.
(Pro tip: “We’ll figure it out” is not a plan. You deserve a plan.)

After: wound care, pain, and “how long until I feel normal?”

Healing time depends heavily on procedure type and location. Some people feel functional within days after minor
procedures, while wide excisions may require weeks to months of healing and ongoing wound care. Pain, drainage,
odor concerns, and mobility limitations are common topicsso ask early about dressings, showering, movement
restrictions, and what “normal healing” should look like.

Potential risks and trade-offs (the honest list)

• Scarring: HS itself scars; surgery can reduce HS activity in an area but may leave surgical scars.
• Recurrence: even after surgery, HS can recureither at edges or in new areas.
• Infection or delayed healing: risk varies by procedure, location, and health factors.
• Reduced range of motion (temporary): especially in axillary (armpit) procedures.
• Need for additional procedures: some people need staged treatment over time.

Specific examples (because “it depends” is true but not helpful)

Example 1: Localized axillary tunnels (Hurley II pattern)

Someone has recurring armpit flares in the same two spots with tunnel formation. They’ve tried topical washes and
oral antibiotics, and inflammation is betterbut those tunnels keep reigniting. A dermatologist might recommend
deroofing of those specific tracts, paired with an ongoing medical plan to prevent new lesions.

Example 2: Extensive groin disease with interconnected tracts (Hurley III pattern)

Someone has long-standing groin HS with widespread scarring and interconnected tunnels that affect daily movement.
In this setting, wide excision may be discussed, possibly with flap or graft reconstruction depending on the size
and location. Medical therapy may still be used before/after to reduce inflammatory activity in surrounding areas.

Example 3: Mild-to-moderate HS with follicular pattern flares

Someone has recurring bumps in friction areas without extensive scarring yet, and flares seem tied to follicular
activity. Laser hair removal (when appropriate for skin tone and hair type) may be discussed as part of an overall
plansometimes alongside medications and friction-reducing strategies.

Questions to ask at your surgical consult

• Which procedure are you recommending, and why is it the best fit for my HS pattern?
• What are the realistic goals: fewer flares, less pain, improved movement, fewer tunnelsor all of the above?
• How will the wound be closed (or will it heal gradually), and what does wound care look like day-to-day?
• How long until I can return to school/work/exercise?
• What are the most common complications in this location?
• How do you coordinate HS meds (including biologics) around surgery?
• What are the odds I’ll need another procedure later?
• Will insurance likely cover this procedure and supplies? If not, what are the cost ranges?

Experiences people share after HS surgery (about )

HS surgery stories are rarely “one and done,” and that’s not a failureit’s just how chronic disease works.
People often describe the decision to pursue surgery as a mix of hope and exhaustion: hope that a stubborn area
can finally quiet down, and exhaustion from planning life around flares.

A common theme is that the emotional weight can be as real as the physical recovery. Some people feel relieved the
moment a long-term “problem spot” is treatedlike they can finally wear certain clothes again, move their arm
without bracing for pain, or sit comfortably for longer stretches. Others describe a weird grief period: “I’m glad
I did it… but I didn’t realize how much HS had been stealing my energy until I started healing.”

Many patients say the biggest surprise isn’t the procedureit’s the logistics. Wound care can feel like a part-time
job at first, especially for larger excisions or hard-to-reach areas. People who felt most prepared often mention
having a clear supplies plan, a realistic schedule (including help for the first week), and a clinician who was
easy to contact for “Is this normal?” questions. They also emphasize that comfort isn’t just pain medicationit’s
being able to move, sleep, and get through the day without friction constantly irritating the area.

Another repeated experience: expectations matter a lot. Patients who felt satisfied often went into surgery
understanding that the goal is usually “major improvement” rather than “HS never exists again anywhere forever.”
When surgeons and dermatologists framed surgery as a targeted reset for specific tunnelsplus ongoing prevention
with medical therapypeople felt less blindsided by the possibility of future treatment elsewhere.

Some people share that body-image worries showed up unexpectedly. Scars can be emotionally complicatedespecially
after years of HS already leaving marks. But many also describe a trade they would make again: “I’d rather have a
stable scar than unpredictable flares.” Support groups and HS-informed counseling can be helpful if surgery brings
up anxiety, isolation, or confidence issues.

Finally, people often say the best “recovery hack” is not a hack at all: it’s advocating for yourself. Asking for
a real pain plan. Asking for written wound-care steps. Asking who to contact after hours. Asking what success
looks like at 2 weeks, 6 weeks, and 3 months. HS is already exhaustingyour care team should make the process more
structured, not more confusing.

Conclusion

HS surgery isn’t one choiceit’s a set of options ranging from quick procedures to more extensive excisions.
The “right” approach depends on where your HS shows up, how deep the tunnels go, and what kind of recovery fits
your life. For many people, the best results come from combining procedures (to remove persistent tunnels or scarred
areas) with medical therapy (to reduce inflammation and prevent new lesions). If you’re considering surgery, a
consult with an HS-experienced dermatologist or surgeon can turn “I’m stuck” into an actual plan.

Sources consulted (no links)

• Mayo Clinic
• Cleveland Clinic
• MedlinePlus (NIH)
• PubMed (NIH)
• Journal of the American Academy of Dermatology (JAAD)
• JAMA Dermatology
• Hidradenitis Suppurativa Foundation
• University of Michigan Health
• Health.com (U.S. health publication)
• Dermatology Times (U.S. dermatology news)